Provider Demographics
NPI:1285273151
Name:WATSON, MARSHALL (CRNA)
Entity type:Individual
Prefix:
First Name:MARSHALL
Middle Name:
Last Name:WATSON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 ECHO SPRINGS CIR
Mailing Address - Street 2:
Mailing Address - City:TRAFFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15085-1433
Mailing Address - Country:US
Mailing Address - Phone:814-882-5802
Mailing Address - Fax:
Practice Address - Street 1:565 COAL VALLEY RD
Practice Address - Street 2:
Practice Address - City:JEFFERSON HILLS
Practice Address - State:PA
Practice Address - Zip Code:15025-3703
Practice Address - Country:US
Practice Address - Phone:412-469-5000
Practice Address - Fax:412-469-7174
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-24
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN591759163W00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse